Automated delivery of alerts with confirmation of receipt

ABSTRACT

Systems and methods are provided for delivering information as alerts. Alerts may be sent to one or more destinations at one or more times, with possible destinations including, e.g., one or more dedicated software clients, portable wireless devices, and/or email accounts, among many other possibilities. The sender may receive confirmation of, and/or may keep persistent records of, among several possibilities, transmission of one or more of the alerts, receipt of one or more of the alerts by devices at their respective destinations, and/or presentation of the alert to the intended recipient. According to an embodiment of the invention, an alert may be used to delivery medical information, which may include an urgent result of a medical test that has been performed on a patient.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.12/346,190, filed 30 Dec. 2008 and titled “Automatic Delivery of Alertswith Confirmation of Receipt”, which is incorporated herein byreference.

This application contains material relating to medical services andmedical information. The provision and handling of some medical servicesand medical information are regulated, as for example, by the UnitedStates Government, the various state governments, and other governmentalagencies within the United States and elsewhere. The disclosure hereinis made solely in terms of logical and financial possibility andadvantage, without regard to possible statutory, regulatory, or otherlegal considerations. Nothing herein is intended as a statement orrepresentation of any kind that any method or process proposed ordiscussed herein does or does not comply with any statute, law,regulation, or other legal requirement whatsoever, in any jurisdiction;nor should it be taken or construed as doing so.

BACKGROUND

Delivery of certain information may be urgent. For example, the resultof a medical test performed in a laboratory may indicate the possibleexistence of a life-threatening medical condition. Laws, regulations,and/or established procedures may specify that such results are to bedelivered promptly.

Such procedures may involve, for example, attempting to contact thephysician who ordered the test so that the results may be deliveredpersonally. Finding the physician so that the result may be delivered,however, may be burdensome, especially given the multiple andproliferating ways to reach any individual. The multiple diverse meansof communication also complicate ensuring that any urgent result hasbeen delivered and/or seen by the intended recipient.

BRIEF SUMMARY OF THE INVENTION

The invention relates to delivering information and automaticallyrecording delivery thereof. More specifically, it relates to delivery ofinformation, such as the results of medical tests, in the form ofelectronic alerts. Delivery of an alert according to an embodiment ofthe invention may be recorded automatically. Confirmation may also bereceived that the intended recipient has received the alert, and suchconfirmation may also be recorded automatically.

According to an embodiment of the invention, a method is provided oftransmitting an urgent alert from a computer system that comprises atleast one processor, at least one network interface operatively coupledto at least one of the processors, and a computer-readable storagemedium operatively coupled to at least one of the processors. The methodcomprises transmitting through at least one of the network interfaces,to a client, first information that comprises an alert. The method alsocomprises receiving through at least one of the network interfacessecond information indicating that the client has presented the alert ata first time and, in response to receiving the second information,storing in the computer-readable storage medium a record that the firstinformation was presented, the record comprising the first time.

In an embodiment of the invention, the method comprises receivingthrough at least one of the network interfaces third informationindicating that the client has received input from a user at a secondtime acknowledging receipt of the presented alert and, in response toreceiving the third information, storing in the computer-readablestorage medium a record of the input from the user, the recordcomprising the second time.

In an embodiment of the invention, the method comprises waiting apredetermined time, during which no information is received through anyof the network interfaces indicating that the client has received inputfrom a user acknowledging receipt of the presented alert. The methodalso comprises, after the predetermined time has passed, transmittingthrough at least one of the network interfaces third informationindicating that the alert has not been acknowledged within thepredetermined time.

In an embodiment of the invention, the alert according to the methodcomprises an indication that a result of a laboratory test performedupon a patient has become available. In a further embodiment of theinvention, the alert comprises indication that the result of thelaboratory test is outside of a reference range.

Embodiments of the invention also include computer systems includingprogramming to carry out the methods described above andcomputer-readable media encoded with instructions that, when executed byone or more processors within a computer system, cause the computersystem to carry out the methods described above.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is illustrated in the figures of the accompanyingdrawings, which are meant to be exemplary and not limiting, and in whichlike references are intended to refer to like or corresponding things.

FIG. 1 is a block diagram depicting a programmable digital computeraccording to the prior art.

FIG. 2 is a block diagram depicting internetworked computer systemsaccording to the prior art.

FIG. 3 depicts a workflow in which a physician may register to receivealerts according to an embodiment of the invention.

FIG. 4 depicts a workflow in which an alert may be sent according to anembodiment of the invention.

FIG. 5 depicts in schematic form a window presenting an alert accordingto an embodiment of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The invention disclosed herein relates to automated processes fordelivering information. Although of general utility, the invention maybe described or illustrated herein in terms of applications that involvelaboratory testing, especially in relation to the practice of medicine.The invention is not limited to such applications, however, and no suchlimitation is intended or implied.

Medical practice may involve laboratory testing, e.g., to diagnoseand/or monitor one or more health conditions of a patient. For example,a sample, comprising, e.g., body fluids, cells, or tissues, may becollected. Once collected, the sample may be subjected to one or moreassays, which may measure the absolute or relative level or amount of asubstance or constituent in the sample. (The substance or constituentmeasured in the assay may be referred to as an “analyte.”)

Although some assays may take place, e.g., in a physician's office,samples are commonly delivered to a testing facility, where the assaystake place. Some businesses specialize in providing laboratory testingservices. Additionally, some hospitals or medical practices operatetheir own laboratories, and, depending on circumstances, may providetesting services to outside physicians. The word “laboratory” is used ina broad sense herein, and, unless the context requires otherwise,includes both the facility where an assay takes place and the entitythat operates such a facility.

When a physician does not perform an assay personally, e.g., when alaboratory performs the assay, the results of the assay (which may alsobe referred to as the results of the test) may be given to a physician,possibly the one who ordered the test. The result may be reported, e.g.,orally, such as by telephone, or in written or printed form, such as aprinted or electronic report. The report may include, e.g., informationsuch as the identity of the patient, the date, time, and/or location atwhich a sample was collected, the one or more tests and/or panels oftests performed, and values for one or more analytes.

A medical test may be performed, e.g., to diagnose (or rule out) ormonitor one or more medical conditions. An abnormal test result mayindicate that a patient has or may have a particular condition. It istherefore in some cases useful to establish ranges of analyte valuesthat are likely to be found in healthy persons.

A “reference range” may be established for an analyte, and the referencerange may be intended, e.g., to contain the range of values for theanalyte that are expected for most tests performed in healthy people. Areference range most commonly establishes a guideline, but it may not beexpected to definitively identify disease: a healthy person may have avalue for an analyte that is outside of the corresponding referencerange, and a person may have a medical condition even though an analytecommonly indicative of that condition is inside the reference range.

One basis for establishing reference ranges, for example, applies toanalytes that may be expected to have values that, in a healthypopulation, obey a normal distribution. For such analytes, referenceranges may be defined so that, for any analyte, 95% (or two standarddeviations) of the healthy population will have values within thatrange. By definition, for such ranges, 5% of the healthy population willhave values for any analyte that are outside of the reference range forthat analyte.

Depending on circumstances, reference ranges applicable to anyparticular test may be established, e.g., by the laboratory, by one ormore medical practices, or by legal authority, such as by regulationsissued by one or more authorities. When providing a test result, alaboratory may include any applicable reference range, e.g., by printingthe values defining the reference range next to the value of thecorresponding analyte. When a value for an analyte is outside of thereference range, the report may also indicate this fact, e.g., byprinting the value, the name of the analyte, and/or the reference rangein boldface type.

Besides establishing reference ranges for one or more analytes, asdescribed above, a laboratory, medical practice, legal authority, orother source may establish guidelines for analyte values that mayindicate that a patient has a life-threatening condition and may requireimmediate attention. A result indicating such an analyte value may bereferred to herein as a “critical result.” Although not every value thatis outside a reference range will be considered critical, criticalresults may be expected in most cases to be outside the applicablereference range. In some cases, a reference range may not even exist:for some toxic substances, such as methanol, for example, any valueother than zero may be considered critical.

Additionally, reference ranges and threshold values for critical resultsmay vary, e.g., depending on the population to which the patientbelongs. For example, in some cases, different values may apply toinfants, children, and adults.

Some tests may be considered “critical tests,” which may mean, forexample, that the result of the test may be considered a criticalresult, no matter what the value. For example, a Gram stain of abacterial sample may be necessary to select the antibiotic used to treata life-threatening infection. In some cases, a physician may indicatewhen ordering the test that the test is critical.

Laboratories may establish policies for reporting critical tests. Forexample, a laboratory may require that, within twenty minutes ofobtaining a critical result, that result must be delivered and aconfirmation of delivery must be received directly from the orderingphysician. Such policies may be the result of one or more initiativestaken by the laboratory and/or may be required by one or more legaland/or regulatory authorities, standards-setting organizations, or otherauthorities. To document compliance with applicable policies and/orregulations, a laboratory may record each step taken in attempting todeliver a critical result to the physician as well as the confirmationfrom the physician that the result was delivered.

Besides critical results, other test results may be designated forexpedited delivery, e.g., in response to a request from the orderingphysician. A laboratory may treat a test accompanied by such a requestas it treats a critical test or it may treat such a test differently.One or more classes of expedited handling may be created, depending onthe laboratory and/or circumstances.

Delivery of information according to an embodiment of the invention,including, e.g., results of medical tests, may be practiced usingprogrammable digital computers. FIG. 1 is a block diagram of arepresentative prior art computer. The computer system 140 includes atleast one processor 145, such as, e.g., an Intel Core™ 2 microprocessoror a Freescale™ PowerPC™ microprocessor, coupled to a communicationschannel 147. The computer system 140 further includes an input device149 such as, e.g., a keyboard or mouse, an output device 151 such as,e.g., a CRT or LCD display, a communications interface 153, a datastorage device 155 such as a magnetic disk or an optical disk, andmemory 157 such as Random-Access Memory (RAM), each coupled to thecommunications channel 147. The communications interface 153 may becoupled to a network (not depicted) such as the Internet.

Although the computer system 140 is shown in FIG. 1 to have only asingle communications channel 147, a person skilled in the relevant artswill recognize that a computer system may have multiple channels (notdepicted), including for example one or more busses, and that suchchannels may be interconnected, e.g., by one or more bridges. In such aconfiguration, components depicted in FIG. 1 as connected by a singlechannel 147 may interoperate, and may thereby be considered to becoupled to one another, despite being directly connected to differentcommunications channels.

One skilled in the art will recognize that, although the data storagedevice 155 and memory 157 are depicted as different units, the datastorage device 155 and memory 157 can be parts of the same unit orunits, and that the functions of one can be shared in whole or in partby the other, e.g., as RAM disks, virtual memory, etc. It will also beappreciated that any particular computer may have multiple components ofa given type, e.g., processors 145, input devices 149, communicationsinterfaces 153, etc.

The data storage device 155 and/or memory 157 may store instructionsexecutable by one or more processors 145 or kinds of processors, data,or both. Some groups of instructions, possibly grouped with data, maymake up one or more programs, which may include an operating system 160such as Microsoft Windows XP® or Vista™, Linux®, Mac OS®, or Unix®.Other programs 162 may be stored instead of or in addition to theoperating system. It will be appreciated that a computer system may alsobe implemented on platforms and operating systems other than thosementioned. Any operating system 160 or other program 162, or any part ofeither, may be written using one or more programming languages such as,e.g., Java®, C, C++, C#, Visual Basic®, VB.NET®, Perl, Ruby, Python, orother programming languages, possibly using object oriented designand/or coding techniques.

One skilled in the art will recognize that the computer system 140 mayalso include additional components and/or systems, such as networkconnections, additional memory, additional processors, networkinterfaces, input/output busses, for example. One skilled in the artwill also recognize that the programs and data may be received by andstored in the system in alternative ways. For example, acomputer-readable storage medium (CRSM) reader 164, such as, e.g., amagnetic disk drive, magneto-optical drive, optical disk drive, or flashdrive, may be coupled to the communications bus 147 for reading from acomputer-readable storage medium (CRSM) 166 such as, e.g., a magneticdisk, a magneto-optical disk, an optical disk, or flash RAM.Alternatively, one or more CRSM readers may be coupled to the rest ofthe computer system 140, e.g., through a network interface (notdepicted) or a communications interface 153. In any such configuration,however, the computer system 140 may receive programs and/or data viathe CRSM reader 164. Further, it will be appreciated that the term“memory” herein is intended to include various types of suitable datastorage media, whether permanent or temporary, including among otherthings the data storage device 155, the memory 157, and the CSRM 166.

Two or more computer systems 140 may be connected, e.g., in one or morenetworks, via, e.g., their respective communications interfaces 155and/or network interfaces (not depicted). FIG. 2 is a block diagram ofrepresentative prior art interconnected networks 180, such as may beuseful in connection with embodiments of the invention.

A network 182 may, for example, connect one or more workstations 184with each other and with other computer systems, such as file servers186 or mail servers 188. The connection may be achieved tangibly, e.g.,via Ethernet® or optical cables, or wirelessly, e.g., through use ofmodulated microwave signals according to the IEEE 802.11 family ofstandards. A computer system that participates in the network may senddata to another computer system in the network via the networkconnection.

One use of a network 180 is to enable a computer system to provideservices to other computer systems, consume services provided by othercomputer systems, or both. For example, a file server 186 may providecommon storage of files for one or more of the workstations 190 on anetwork 182. A workstation 190 sends data including a request for a fileto the file server 186 via the network 182 and the file server 186 mayrespond by sending the data from the file back to the requestingworkstation 190.

As will be recognized by those skilled in the relevant art, the terms“workstation,” “client,” and “server” are used herein to describe acomputer's function in a particular context. A workstation may, forexample, be a computer that one or more users work with directly, e.g.,through a keyboard and monitor directly coupled to the computer system.A computer system that requests a service through a network is oftenreferred to as a client, and a computer system that provides a serviceis often referred to as a server. But any particular workstation may beindistinguishable in its hardware, configuration, operating system,and/or other software from a client, server, or both.

Further, a computer system may simultaneously act as a workstation, aserver, and/or a client. For example, as depicted in FIG. 2, aworkstation 192 is connected to a printer 194. That workstation 192 mayallow users of other workstations on the network 182 to use the printer194, thereby acting as a print server. At the same time, however, a usermay be working at the workstation 192 on a document that is stored onthe file server 186.

A network 182 may be connected to one or more other networks 180, e.g.,via a router 196. A router 196 may also act as a firewall, monitoringand/or restricting the flow of data to and/or from a network 180 asconfigured to protect the network. A firewall may alternatively be aseparate device (not pictured) from the router 196.

A network of networks 180 may be referred to as an internet. The term“the Internet” 200 refers to the worldwide network of interconnected,packet-switched data networks that uses the Internet Protocol (IP) toroute and transfer data. A client and server on different networks maycommunicate via the Internet 200. For example, a workstation 190 mayrequest a World Wide Web document from a Web Server 202. The Web Server202 may process the request and pass it to, e.g., an Application Server204. The Application Server 204 may then conduct further processing,which may include, for example, sending data to and/or receiving datafrom one or more other data sources. Such a data source may include,e.g., other servers on the same network 206 or a different one and/or aDatabase Management System (“DBMS”) 208.

The terms “client” and “server” may describe programs and runningprocesses instead of or in addition to their application to computersystems described above. Generally, a (software) client may consumeinformation and/or computational services provided by a (software)server.

A client and server, in this sense, may be in the same or differentcomputer systems, depending on the implementation of the software and/orthe users' needs, among many possible considerations. When the clientand server are in separate computer systems, they may communicate, e.g.,by using one or more facilities provided by one or more operatingsystems and/or other programs to send and receive data through one ormore networks 180 that connect the computer systems.

The term “server” may be used without qualification, e.g., to refer to acomputer system that provides a service, as described above, or to referto one or more programs and/or processes in such a system, by virtue ofwhich the computer system provides such a service. In somecircumstances, the term “server” may, in a single discussion, refer atone time to a computer system and at another time to software in thecomputer system, with the precise meaning supplied by context. The term“client” may be similarly used in either or both senses of the term.

According to embodiments of the invention, networked computer systems,e.g., as described above, are used to deliver information. In anembodiment of the invention, a confirmation may be recorded, e.g., by aserver, that information was delivered, e.g., from the server to aclient. A second confirmation may be recorded separately, e.g., by theserver, that a person received the information from the client.

For example, an embodiment of the invention may relate to the provisionof medical tests by a laboratory. In such an embodiment, a server maysend information, e.g., the results of one or more tests, to a clientused by, e.g., the physician who ordered the test. In response toreceiving the information, the client may both send a confirmation ofreceipt, e.g., to the server from which the information was received,and cause the information to be presented, e.g., in the form of an alertwindow within a graphical user interface on an electronic display devicethat is coupled to the client computer system.

FIG. 3 depicts a workflow 200 in which a physician may register to use aservice that provides alerts for test results, in connection with anembodiment of the invention. The workflow 200 begins in block 205, inwhich the physician establishes a business relationship with alaboratory, e.g., by opening an account. The activities comprised byestablishing the relationship 205 according to an embodiment of theinvention may vary, depending, e.g., on circumstances such as thelaboratory's internal procedures and legal (including statutory and/orregulatory) and/or insurance requirements.

For example, in connection with an embodiment of the invention, creatingthe relationship 205 may include confirming that the physician ispermitted to order medical tests under the applicable legal and/orregulatory regime and/or arranging for financial responsibility for anyordered tests. Establishing such a relationship 205 may include, e.g.,one or more personal and/or telephonic contacts between a physician andone or more representatives of a laboratory and/or the transfer of oneor more relevant documents. In some circumstances, if a physician isassociated with a medical practice, the medical practice may establishthe relationship with the laboratory, and the physician may takeadvantage of that relationship. In addition to or instead of theforegoing, if a physician is associated with a medical practice, one ormore other persons associated with the medical practice may perform oneor more actions on behalf to the physician to establish the relationshipbetween the physician and the laboratory.

Block 210 represents a physician's registration to use an alert serviceassociated with a laboratory according to an embodiment of theinvention. The precise contents of this step may depend, e.g., on theembodiment of the invention and details of the implementation. But itwill be appreciated by those skilled in the relevant arts thatregistration may include, for example, a request from, or consent by,the physician to receive alerts electronically.

In block 215, client software is installed on one or more computers,which may be situated so that the physician may be able to receivealerts through them.

In block 220, the service is configured, e.g., by the physician, totransmit alerts to one or more clients according to an embodiment of theinvention. It will be appreciated that configuration 220 may varysubstantially depending upon the implementation of the system. But itwill be further appreciated that configuration 220 may includedirecting, e.g., a server to send alerts associated with one or morephysicians and/or accounts to one or more destinations, which mayinclude, e.g., one or more installed instances of client softwareaccording to an embodiment of the invention.

According to one embodiment of the invention, for example, configuration220 may include launching the client software and using the client toenter information about the physician's account with the laboratory.Such information may in an embodiment of the invention be stored, e.g.,persistently within the client computer, and the client software may beconfigured to automatically contact a server associated with thelaboratory and use some or all of the entered information and/or otherinformation to register itself as a destination for alerts. Thecommunication between the client and the server may in an embodiment ofthe invention cause information to be stored persistently by the client,the server, or both.

Such configuration may be obtained by the software, e.g., duringinstallation of the client software, in addition to or instead of byrunning the client software directly.

In an embodiment of the invention, configuration 220 may include otheruse of computer networks, such as the Internet, in addition to orinstead of that described above. For example, the World Wide Web may beused to specify one or more destinations for alerts according to anembodiment of the invention. A Web form, for example, may allow a userto specify one or more destinations for alerts, including, e.g., one ormore instances of client software, such as described herein. Otherpossible destinations for alerts may include, without limitation, one ormore email accounts, pagers, voice mailboxes, telephone numbers, SMSaccounts and/or other synchronous and/or asynchronous means ofcommunication.

According to an embodiment of the invention, configuration may include,e.g., specifying groups of one or more such destinations and/or orderingdestinations and/or groups in a sequence for receipt of alerts. Forexample, a user may specify that an attempt is first to be made todeliver an alert to a particular installed client. If that attemptfails, or confirmation of receipt of the delivered alert is not receivedwithin a specified time, a second attempt is to made to deliver thealert to one or more other installed clients and/or email accounts.Depending on the embodiment of the invention, three or more levels ofdestinations may be specified.

According to an embodiment of the invention, the last level ofdestinations may include one or more telephone numbers, e.g., that maybe used to contact the physician directly, so that a person may deliverthe results personally when automatic delivery cannot be confirmed. Insuch an embodiment, configuration 220 may include providing one or moresuch telephone numbers.

FIG. 4 depicts a workflow 250 for generating alerts according to anembodiment of the invention. In connection with this discussion of theworkflow 250 depicted in FIG. 4, it is assumed that the physicianalready has some kind of relationship, e.g., an account with a providerof laboratory services, such as may result from the workflow 200 of FIG.3.

In the depicted embodiment of the invention, the workflow begins inblock 260, when the physician orders a laboratory test for a patient.Ordering a test in connection with an embodiment of the invention mayinclude, e.g., completing a requisition, which may include supplyinginformation electronically or on a paper form. Information on arequisition may include, for example, information identifying and/orotherwise associated with the patient, a specification of one or moretests to be performed, information identifying and/or otherwiseassociated with the physician, and/or other information. A requisitionmay also provide for designating one or more tests as critical orotherwise requesting special handling of the test and/or results.

The completed requisition may then be transmitted, e.g., physically orelectronically to the laboratory. The requisition may also beaccompanied by one or more samples of biological material, such as, forexample, body fluids and/or tissues obtained from the patient.Alternatively, the sample may be obtained, e.g., by the laboratory at afacility for collection of such material.

In block 265, an assay is performed upon the sample, resulting in aresult that comprises at least one value for at least one analyte. Thisresult is recorded, e.g., electronically, in block 270 according to anembodiment of the invention. Recording may include, e.g., manual entryof one or more values for one or more analytes and/or automaticacquisition of one or more such values from laboratory apparatus.

Block 275 represents determining whether a result is one that may bedelivered in connection with one or more alerts in an embodiment of theinvention. For example, in an embodiment of the invention, alerts may bea preferred means for delivery of all critical results (which mayinclude all results of critical tests). Other results may be eligiblefor delivery of results via alerts, including, for example, when theordering physician requests such delivery. If the result is not one thatmay be delivered by alert, then the result is delivered by other means,such as those known to the prior art, in block 280.

If a result is eligible to be delivered by an alert, in an embodiment ofthe invention, it is determined in block 285 whether the physician isregistered to receive alerts. If not, then the result may be transmittedelsewhere for personal delivery to the physician in block 290. Forexample, if a physician is not registered to receive a critical resultas an alert according to an embodiment of the invention, a computersystem handling the result may transmit the result and/or otherinformation associated with the test, the patient, or both, to anothercomputer system associated with a call center. A representative of thelaboratory may then attempt to contact the physician at one or moretelephone numbers to deliver the result, and possibly to obtainconfirmation that the result has been delivered.

If the physician may accept results as alerts, one or more alerts aretransmitted in block 295. In an embodiment of the invention, a serverattempts to transmit the alert, e.g., to one or more clients via one ormore networks and/or direct connections between computer systems.According to an embodiment of the invention, alerts may be transmittedto some or all other destinations, such as those registered in block 220of FIG. 3.

In an implementation of the invention, an alert may be transmittedsimultaneously (or effectively so) to multiple destinations and/or viamultiple channels. For example, an alert may be transmitted to one ormore software clients within one or more computer systems, while at thesame time being transmitted to one or more email accounts and/or textmessaging (e.g., SMS) devices. It will be appreciated that a computersystem using only a single interface and/or other shared resource may,in an implementation of the invention, not be able to be transmittingmore than one alert at any instant, but that alerts may be, e.g., queuedin rapid (or even immediate) succession for transmission and thentransmitted individually as resources for transmission become available;such alerts may be considered effectively to have been transmittedsimultaneously.

In an embodiment of the invention a client capable of receiving alertsis executing, e.g., as a background application on a computer systemused by or otherwise associated with the physician who ordered the test.It will be appreciated that, depending on the embodiment of theinvention, the client may receive information from the server accordingto any of several methods, including without limitation, periodicallypolling a server and/or by listening for a network connection initiatedby the server.

Upon receiving an alert, the client may cause to be presented, e.g., bydisplaying a window such as FIG. 5 depicts, information from and/orassociated with the alert. In an embodiment of the invention, the clientmay cause the computer system to act to bring the alert to a user'sattention, e.g., by prominently displaying the alert window, producingone or more sounds, and/or presenting, modifying, hiding, or removingone or more user interface elements.

In an embodiment of the invention, the content of the alert transmittedin block 295 (FIG. 4) may include information that, e.g., identifies thepatient and/or the test and includes one or more values for one or moreanalytes. An alert may in an embodiment of the invention include one ormore reasons for delivery of the result as an alert, such as, e.g., theinclusion of a critical result or the ordering physician's request forsuch delivery.

In an embodiment of the invention, some or all information in the alertmay be encrypted in transit, e.g., by the server, and decrypted, e.g.,on receipt by the client. In an embodiment of the invention, the alertmay omit some or all specific information associated with, e.g., thetest, the patient, and/or the result, and, in an embodiment of theinvention, the alert may direct the recipient to contact arepresentative of the laboratory, e.g., at a call center as describedabove, to obtain the omitted information.

In an embodiment of the invention, transmission of one or more alerts inblock 295 includes recording the transmissions, separately or as agroup, e.g., in a database. One or more clients may confirm receipt ofthe alert by transmitting information, e.g., back to the originatingserver, and, according to an embodiment of the invention, any suchconfirmation may be recorded in a database. Confirmation of receipt isnot limited to client software installed, e.g., as described above inconnection with block 215 of FIG. 3, but may come from any systemcapable of acknowledging receipt. For example, an SMTP server mayconfirm that it has successfully received an email message, which, inconnection with an embodiment of the invention, may include an alert.

In an embodiment of the invention, confirmation may be obtained that theresults have been presented to, e.g., the ordering physician, and suchconfirmation may be separate from the confirmation that the alert wasreceived, e.g., by a client or other system. For example, a clientrunning on a computer system may receive an alert transmitted from alaboratory server through the Internet. In response to receiving thealert, the client may present, e.g., an alert window on an electronicdisplay device and may indicate, e.g., by conventional user interfaceelements, that the user may dismiss the alert by providing appropriateinput, e.g., through a pointing device. On receiving such input, in anembodiment of the invention, the client may transmit, e.g., to theserver, confirmation that the user has dismissed the alert in responseto its presentation, and the transmission may be automatic, i.e.,occurring without further input or other intervention by the user.

In an embodiment of the invention, confirmation that results have beenpresented, e.g., to the ordering physician may be entered manuallyand/or electronically, e.g., by a representative of the laboratory uponreceipt by the laboratory of a telephone call or other communicationfrom the physician, requesting results of the test. Such confirmationmay be obtained, e.g., in response to an alert that contains onlylimited information, such as described above. In connection with anembodiment of the invention, the representative may require additionalinformation or interaction from the physician before enteringconfirmation of presentation to the physician. For example, therepresentative may request that the physician repeat the presentedresults to confirm correct receipt.

Block 300 of FIG. 4 represents determining that confirmation ofpresentation has been received within a specified time period, accordingto an embodiment of the invention. For example, in an embodiment of theinvention, confirmation of presentation must be received, if at all,within twenty minutes of the result having become available. On receipt,confirmation of the presentation of the results may in an embodiment ofthe invention be stored in a database in block 305.

If confirmation is not received in the specified time, then, in anembodiment of the invention, the result is transmitted elsewhere inblock 290 for alternate delivery, as described above.

FIG. 5 depicts an window 350 that presents an alert according to anembodiment of the invention. The window 350 may be presented, e.g.,within a graphical user interface presented on an electronic displaydevice that is connected to a computer system. One or more input devices(not pictured), such as, for example, a keyboard and/or a pointingdevice such as a mouse, may be used to identify and/or select itemswithin the displayed window and/or otherwise to provide information tothe computer system.

As depicted in FIG. 5, the alert window 350 includes a caption and/ortitle, such as “Laboratory Alert.” In an embodiment of the invention,the window may be branded, e.g., with the name of the application, thealert service, and/or the name of a laboratory. In the depictedembodiment of the invention, a second area 362 at the bottom of thewindow is provided within which other information may be provided,including but not limited to, for example, branding information,advertising, news, and/or information associated with one or more drugs,tests, results, and/or patients.

The window 350 in the depicted embodiment of the invention also includesa drop-down menu 364. When the item labeled “MENU” 364 is selected, amenu (not pictured) drops down and presents the user with one or moreoptions. The available options will depend upon the implementation, butmay in an embodiment of the invention include, for example, programsettings and/or configuration. In an embodiment of the invention, theclient application may also be represented, e.g., by an icon in a dockor system tray, and selecting the icon may cause the same menu or asimilar one to be presented in association with the icon, even when thealert window 350 is not displayed.

The alert window 350 includes a content area 368 where, in an embodimentof the invention, the content of the alert is presented. The contentarea 368, as depicted, may include information that identifies thepatient 370, the test requisition number 372, and a time and date stamp374 that may indicate when the alert was transmitted or received. In thedepicted embodiment of the invention, the content area 368 may alsoinclude one or more results 376, with each result including the name 378of an analyte and the value 380 measured in the assay.

In the depicted embodiment of the invention, the content area 368includes a confirmation button 390 labeled “Received.” In an embodimentof the invention, the user may confirm receipt of the alert by selectingthe confirmation button 390. Selecting the confirmation button 390 mayin an embodiment of the invention cause confirmation of presentation tobe sent, e.g., as described above.

Selecting the confirmation button 390 may in an embodiment of theinvention cause the alert window 350 to be concealed, e.g., byminimizing and/or hiding the alert window 350.

While the invention has been described and illustrated in connectionwith preferred embodiments, many variations and modifications as will beevident to those skilled in this art may be made without departing fromthe spirit and scope of the invention, and the invention is thus not tobe limited to the precise details of methodology or construction setforth above as such variations and modifications are intended to beincluded within the scope of the invention. Except to the extentnecessary or inherent in the processes themselves, no particular orderto steps or stages of methods or processes described in this disclosure,including the Figures, is implied. In many cases the order of processsteps may be varied without changing the purpose, effect, or import ofthe methods described.

We claim:
 1. A method of transmitting an alert from a computer systemparticipating in a data network with a plurality of clients andconfigured to communicate via the data network with a plurality ofdestinations, the computer system comprising at least one processor, amemory operatively coupled to at least one of the processors, and acomputer-readable storage medium operatively coupled to at least one ofthe processors, the method comprising: storing information thatassociates a recipient with a plurality of the destinations including afirst destination that is a first client and a second destination thatis not a client; transmitting via the data network, to the first client,first information that comprises an alert; waiting a predetermined time,immediately following transmission of the first information, duringwhich no information is received indicating that the first client hasreceived user input acknowledging receipt of the alert; consequent toelapsing of the predetermined time, transmitting via the data network,to a destination that is not the first client, third informationassociated with the alert; receiving via the data network secondinformation indicating that the first client has executed instructionsto cause the first client to present the alert visually, on anelectronic display directly coupled to the first client, at a firsttime, wherein the second information includes the first time and doesnot indicate whether the first client has received user inputacknowledging receipt of the alert; and in response to receiving thesecond information, storing in the computer-readable storage medium arecord that the first information was presented by the first client, therecord comprising the first time.
 2. The method of claim 1, wherein thethird information indicates that the alert has not been acknowledgedwithin the predetermined time.
 3. The method of claim 1, wherein thedestination that is not the first client is the second destination. 4.The method of claim 3, wherein the second destination is a computersystem associated with a call center.
 5. The method of claim 1, whereinthe destination that is not the first client is a computer systemassociated with a call center.
 6. The method of claim 1, wherein: theinformation that associates the recipient with the plurality of thedestinations comprises information that associates the recipient with athird destination that is a second client; the destination that is notthe first client is the third destination; and the third informationcomprises the alert.
 7. A computer system for transmitting alerts,comprising: at least one processor; a computer-readable storage mediumoperatively coupled to at least one of the processors; and a memory,operatively coupled to at least one of the processors; wherein thecomputer system is configured to participate in a data network with aplurality of clients and to communicate via the data network with aplurality of destinations; and wherein the memory contains instructionsthat, when executed by at least one of the processors, causes thecomputer system to carry out a method that comprises storing informationthat associates a recipient with a plurality of the destinationsincluding a first destination that is a first client and a seconddestination that is not a client; transmitting via the data network, tothe first client, first information that comprises an alert; waiting apredetermined time, immediately following transmission of the firstinformation, during which no information is received indicating that thefirst client has received user input acknowledging receipt of the alert;and consequent to elapsing of the predetermined time, transmitting viathe data network, to a destination that is not the first client, thirdinformation associated with the alert; receiving via the data networksecond information indicating that the first client has executedinstructions to cause the first client to present the alert visually, onan electronic display directly coupled to the first client, at a firsttime, wherein the second information includes the first time and doesnot indicate whether the first client has received user inputacknowledging receipt of the alert; and in response to receiving thesecond information, storing in the computer-readable storage medium arecord that the first information was presented by the first client, therecord comprising the first time.
 8. The computer system of claim 7,wherein the third information indicates that the alert has not beenacknowledged within the predetermined time.
 9. The computer system ofclaim 7, wherein the destination that is not the first client is thesecond destination.
 10. The computer system of claim 9, wherein thesecond destination is a computer system associated with a call center.11. The computer system of claim 7, wherein the destination that is notthe first client is a computer system associated with a call center. 12.The computer system of claim 7, wherein: the information that associatesthe recipient with the plurality of the destinations comprisesinformation that associates the recipient with a third destination thatis a second client; the destination that is not the first client is thethird destination; and the third information comprises the alert.
 13. Atleast one non-transitory computer-readable storage medium encoded withinstructions that, when executed by at least one processor comprised bya computer system that participates in a data network with a pluralityof clients, is configured to communicate via the data network with aplurality of destinations, and comprises a memory operatively coupled toat least one of the processors, causes the computer system to carry outa method that comprises: storing information that associates a recipientwith a plurality of the destinations including a first destination thatis a first client and a second destination that is not a client;transmitting via the data network, to the first client, firstinformation that comprises an alert; waiting a predetermined timeimmediately following transmission of the first information during whichno information is received indicating that the first client has receiveduser input acknowledging receipt of the alert; and consequent toconclusion of the predetermined time, transmitting via the data network,to a destination that is not the first client, third informationassociated with the alert; receiving via the data network secondinformation indicating that the first client has executed instructionsto cause the first client to present the alert visually, on anelectronic display directly coupled to the first client, at a firsttime, wherein the second information includes the first time and doesnot indicate whether the first client has received user inputacknowledging receipt of the alert; and in response to receiving thesecond information, storing in the computer-readable storage medium arecord that the first information was presented by the first client, therecord comprising the first time.
 14. The at least one computer-readablestorage medium of claim 13, wherein the third information indicates thatthe alert has not been acknowledged within the predetermined time. 15.The at least one computer-readable storage medium of claim 13, whereinthe destination that is not the first client is the second destination.16. The at least one computer-readable storage medium of claim 15,wherein the second destination is a computer system associated with acall center.
 17. The at least one computer-readable storage medium ofclaim 13, wherein the destination that is not the first client is acomputer system associated with a call center.
 18. The at least onecomputer-readable storage medium of claim 13, wherein: the informationthat associates the recipient with the plurality of the destinationscomprises information that associates the recipient with a thirddestination that is a second client; the destination that is not thefirst client is the third destination; and the third informationcomprises the alert.